肾细胞癌并发尿路移行细胞癌的诊断与治疗

Concurrence of renal cell carcinoma and urothelial carcinoma (report of 5 cases)

目的探讨肾细胞癌并发尿路移行细胞癌的临床特点和诊治方法。方法回顾性分析5例肾细胞癌并发尿路移行细胞癌患者的临床资料。男4例,女1例。年龄42～75岁,平均62岁。间歇无痛全程肉眼血尿4例,间歇全程肉眼血尿伴右侧腰痛1例。B超、IVU及CT提示肾肿瘤并发尿路肿瘤4例,肾癌不除外合并同侧肾盂占位1例。结果5例均行根治性手术,4例同时行不同部位肿瘤根治术,1例行分次手术。病理为肾癌并发膀胱癌3例,肾癌并发同侧输尿管癌1例,肾癌并发同侧肾盂癌1例。随访6～18个月,平均11个月。1例术后10个月膀胱肿瘤局部复发,再行经尿道膀胱肿瘤切除术;4例无瘤生存。结论肾细胞癌并发尿路移行细胞癌临床少见,对肾癌患者行泌尿系超声、IVU和术中肾脏剖开检查有助于正确诊断。根治性手术宜同时切除肾癌侧输尿管,以避免残余输尿管发生肿瘤。

Objective To investigate the clinical features,diagnosis and treatment of renal cell carcinoma accompanied by urothelial carcinoma. Methods From January 2002 to December 2003, five patients (4 men and 1 woman;mean age,62 years;age range,42-75 years) with renal cell carcinoma accompanied by transitional cell carcinoma in urinary tract were treated.Of them,4 patients presented with intermittent painless macroscopic hematuria during whole urination and 1 presented with intermittent macroscopic hematuria during whole urination accompanied by right low back pain.B-ultrasound,IVU and CT indicated renal tumor concurrent with urinary tract tumor in 4 cases and renal carcinoma concurrent with ipsilateral pyelic space-occupying diseases in 1 case. Results All the 5 patients underwent radical surgical treatment (4 had synchronous radical resection of tumors at different sites and 1 had 2-stage operations).Histopathological findings confirmed renal cell carcinoma accompanied by urothelial carcinomas (by bladder carcinoma in 3,ipsilateral ureteral carcinoma in 1 and ipsilateral pyelic carcinoma in 1).All the patients were followed up for 6 to 18 months with a mean of 11 months.One patient had recurrence of bladder tumor 10 months after surgical operation and 4 patients were still alive tumor-free to date. Conclusions Concurrence of renal cell carcinoma and urothelial carcinoma is clinically rare. Ultrasonography,excretory urography and intraoperative dissection of the kidney are in favor of identifying this disease.It is essential to remove the ipsilateral whole ureter of renal carcinoma during radical surgery in order to avoid tumor recurrence of ureteral remainder in this kind of patients.